A look at: Advanced practice providers

Paméla Delerme, a certified nurse-midwife in Labor and Birth/OB Triage/Maternal Fetal Medicine at Yale New Haven Children’s Hospital, is one of more than 1,700 advanced practice providers in the health system. CNMs deliver babies and offer patients gynecological, prenatal, and post-pregnancy care.

 Yale New Haven Health employs more than 1,700 advanced practice providers – and counting. They represent 28 percent of the health system’s medical staff and provide care in inpatient and ambulatory settings throughout Connecticut and in Rhode Island.

Yet many patients might not know what an advanced practice provider (APP) is. 

“The term ‘advanced practice provider’ is somewhat misleading, because there isn’t one APP role,” said Kevin Burns, a physician assistant in Emergency Medicine. 

“APP” refers collectively to four distinct healthcare professions: Physician assistant (PA), nurse practitioner (NP), certified nurse-midwife (CNM) and certified registered nurse anesthetist (CRNA).

YNHHS’ APPs work throughout the health system in primary and specialty care areas, including critical care, emergency medicine, internal medicine, palliative care, oncology, psychiatry, surgical services, obstetrics and gynecology, pediatrics and others. All APPs are licensed providers who diagnose and treat patients and prescribe medications. 

“We collaborate with the other members of the healthcare team to deliver a comprehensive patient experience, while providing the highest-quality care within our scope of practice,” said Jeannine Rockefeller, APRN, a family nurse practitioner in Pediatric Neurosurgery and the lead APP in Ambulatory Neurosciences.

So how are APPs different from physicians? Physicians’ education and training period is longer. After earning a bachelor’s degree, prospective physicians spend four more years in medical school, followed by at least three years as a resident – more if their chosen specialty requires it. 

Depending on their role, APPs complete an additional two to six years of education and training after earning a bachelor’s degree. PAs receive a general medical education, with clinical rotations in different specialties. NPs, CRNAs and CNMs usually earn bachelor’s degrees in nursing followed by additional, advanced nursing education and training in a specialty.

Rockefeller was a registered nurse in Yale New Haven Children’s Hospital’s Pediatric Intensive Care Unit for eight years, and decided to pursue her advanced practice registered nurse degree and family nurse practitioner certification.

“I loved working in the PICU, and I learned a lot, but I felt I wanted to know more and have a different kind of impact,” she said. “I wanted to be more involved in driving decision-making.”
She cares for patients in general pediatric neurosurgery clinics and a multidisciplinary pediatric concussion clinic. She also works closely with the Pediatric Neuro-Oncology team to care for patients with neurological tumors. 

Besides their clinical duties, many APPs serve as instructors and participate in YNHHS efforts around safety and quality, clinical redesign, care signature pathways, research, community outreach and leadership. 

Burns is also a paramedic and YNHH’s Emergency Medical Services coordinator, associate medical director, Yale New Haven Hospital Center for EMS, and an assistant professor of emergency medicine at Yale School of Medicine. Additionally, he is director of the YNHH Emergency Medicine APP Residency. 

That residency, which launched in 2015, originally accepted two PAs and NPs as residents per class. Two years ago, the program expanded to four residents.

“We had more than 60 qualified applicants from all over the country for four seats in our latest class,” Burns said. 

The residency program’s growth is just one example of how the PA, NP, CRNA and CNM fields are growing “exponentially,” Rockefeller said. That’s good news, because APPs help meet an increasing demand for care as healthcare organizations nationwide treat more, and sicker, patients. 

YNHHS’ APPs are working to increase awareness of their roles, recently launching a section on the system website. They also created a YNHHS APP Executive Council and have, or are forming, APP councils at each delivery network.

Said Rockefeller, “It’s an exciting time to be an APP at Yale New Haven.”